Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus

Yano, Masahiko; Tsujinaka, Toshimasa; Shiozaki, Hitoshi; Inoue, Masatoshi; Doki, Yuichiro; Yamamoto, Makoto; Tanaka, Eiichi; Inoue, Toshihiko; Monden, Morito

doi:10.1002/(sici)1096-9098(199901)70:1<25::aid-jso5>3.0.co;2-m

Cited by 60 publications

(84 citation statements)

References 22 publications

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“…As shown in Tables 1 and Table 3, seven studies [10][11][12][13][14][15][16] have analyzed the outcome of patients with T4 esophageal cancer who underwent CRT-S. Basically, the combination of 5-FU (200-1000 mg/m 2 ) and CDDP (5-100 mg/m 2 ) was used in all the studies as the primary chemotherapeutic regimen. Although the doses of concurrent radiation varied across studies (36-60 Gy), all CRT in the series were performed as a "planned" treatment before surgical resection.…”

Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

“…The interval between the completion of CRT and surgery was 4-6 weeks in all studies with available related data ( Table 3). 11,13,14,16) Toxicity and mortality due to CRT Yano et al 16) reported that the major toxicities equal to or greater than grade 3 due to CRT (40 Gy/5FU + CDDP) were leukocytopenia in 49% of the patients, gastrointestinal toxicities in 47%. Furthermore, 1 (2%) patient died of treatment-related cause (pancytopenia).…”

Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

“…The reported median perioperative morbidity and mortality rates are 62% 11,14,16) (range, 29%-87%) and 6% 10-12, 14-16) (range, 0%-21%), respectively. Fujita et al 11) reported overall postoperative mortality rate of 7% (2/30), and postoperative complications in 87% (26/30) of their patients with T4 tumors who underwent CRT-S (36 Gy/5-FU + CDDP), including 50% of patients who developed recurrent nerve palsy, 35% respiratory complications, 23% tracheal ischemia, and 23% pyothorax.…”

Section: Resection Rate and Curative Resection Ratementioning

confidence: 99%

“…The overall postoperative mortality rate after surgical resection was 21% (5/24): of 5 deaths, 2 were from postoperative complications involving anastomotic leak; 1, from postoperative pneumonia; 1, from liver failure; and 1, from catheter sepsis. Yano et al 16) analyzed 45 patients who received CRT-S (40 Gy/5-FU + CDDP) and reported respiratory complications, delirium, and recurrent nerve palsy in 43%, 25%, and 21% of their patients, respectively, with an overall morbidity rate of 62% (28/45).…”

Section: Resection Rate and Curative Resection Ratementioning

confidence: 99%

“…8) Previous studies reported the effectiveness of concurrent chemo-radiotherapy (CRT) using this regimen in advanced esophageal cancer including T4 tumors. 9) Thus, two modalities are currently in use for the treatment of esophageal tumors 10,11) ; chemo-radiotherapy followed by surgery (CRT-S) [10][11][12][13][14][15][16] and definitive chemo-radiotherapy (D-CRT). [17][18][19][20][21][22] To the best of our knowledge, there is little or no information on the differences in clinical outcome of patients with T4 esophageal tumors who undergo D-CRT and those who receive CRT-S.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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The outcome of patients with T4 esophageal cancer, defined as a tumor that invades neighboring structures (e.g., aorta, trachea, bronchus, and lung), is extremely poor. Despite recent advances in surgical techniques, these tumors are usually considered inoperable. Two distinct therapeutic options are currently available for T4 esophageal cancers: chemo-radiotherapy followed by surgery (CRT-S), which comprises esophagectomy following down-staging of the tumor by CRT, and definitive chemo-radiotherapy (D-CRT), which is designed to avoid esophagectomy by using maximum doses of irradiation. CRT-S is superior to D-CRT with respect to local control and short-term survival although CRT-S is associated with relatively higher perioperative mortality and morbidity. On the other hand, it is sometimes difficult to achieve local control with D-CRT and the treatment often results in fistula formation, though a complete response to CRT is often associated with better prognosis. Admittedly, the difference in the survival rate between the two modalities is marginal at long-term follow-up due to operative morbidity and inadequate control of distant metastasis in CRT-S. Changes in perioperative management and intensive systemic chemotherapy may enhance the outcome. Randomized controlled trials involving large population samples are needed to define the standard treatment for T4 esophageal cancer.

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Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

Section: Resection Rate and Curative Resection Ratementioning

confidence: 99%

Section: Resection Rate and Curative Resection Ratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

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Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

Makino

Yamasaki

Miyazaki

et al. 2018

Annals of Gastroent Surgery

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Background Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS. Methods A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords “T4 esophageal cancer,” “invading (involving) adjacent organ,” “definitive chemoradiation,” “induction therapy,” “salvage surgery,” and “conversion surgery,” obtaining 28 reports published up to July 2018. Results/Conclusion We found that CS was superior to dCRT with respect to local disease control and short‐term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5‐fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.

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Correlation between histological effects on the main tumors and nodal status after chemoradiotherapy for squamous cell carcinoma of the esophagus

et al. 2005

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Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus

Cited by 60 publications

References 22 publications

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

Correlation between histological effects on the main tumors and nodal status after chemoradiotherapy for squamous cell carcinoma of the esophagus

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